Sacrotuberous ligament strain

Findings

Deep buttock pain, exacerbated by the movement described in Cause, below. Tender on palpation over the superior surface of ischial tuberosity and along the ligament to the sacrum. This tenderness is best palpated with the patient lying prone.

The knee of the side being examined rests on a chair alongside the couch so that the hip is flexed to 90 degrees.

Cause

Caused by a strain of the sacrotuberous ligament, which runs from the ischial tuberosity to the sacrum. The strain occurs when the body weight is on one leg that is flexed at the knee and hip, and at which stage the body is externally rotated and extended towards that leg, such as whilst digging a hole and throwing a spadeful of soil sideways and backwards.

Treatment

a) Electrotherapeutic modalities to settle deep inflammation, such as interferential.

b) injection of the superior surface of the ischial tuberosity with cortisone.

c) Passive hip flexions and massage to reorganize the ligament.

d) Avoid the causative factors.

Sports

Squash - does not regularly occur during the game but during a coaching session. Dangerous movement is requesting playing a repeated, backhand high clearance from close to the front wall.

Golf - non- dominant side, when the golfer hits into a closed, locked hip.

When it occurs it produces a long-lasting deep buttock pain. Steroid injection to the superior surface of the ischial tuberosity definitively helps.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English